soooo confused about IV

Daytonite, BSN, RN · May 6, 2006

see if you can't get something out of these two links:

http://www.nursewise.com/courses/iv_hour.htm - this article by a nurse includes information on electrolytes and what is contained in the various iv solutions along with some information on calculating iv rates.

http://www.muw.edu/nursing/iv.htm - iv fluids, the different types and why you would use them. also includes information on blood transfusion in the second half of the document

psalm_55 · May 6, 2006

THEORETICALLY, an isotonic solution such as NS (0.9%) will remain in the vascular space. (there is minimal exchange between the vascular and tissue fluid.)

hypertonic solution (such as D59 --Dextrose 5% and 0.9% Saline) will pull fluid into the vascular space from the tissues.

hypotonic solution (such as D5W) will move from the vascular space into the tissues.

an easy way to remember what solutions are hypertonic is: any solution with 5% or more of Dextrose is HYPERTONIC* -- except water b/c water is sooooooooooooo hypotonic. (i know some authors list D5.45 as isotonic -- but Matheny, the nurse Guru of electrolytes does not).

*that's b/c glucose (dextrose) is HYPERTONIC (and so is protein).

hope you find this helpful.

guest64485 · May 7, 2006

Ok, so as an earlier poster mentioned, you have several types of solutions

Isotonic - Normal Saline (NS or 0.9%NaCl), Dextrose 5% in water (D5W)**, Lactated Ringers

Hypertonic - 3%NaCl, 5%NaCL, D10W, D5LR, D5NS, D5 + 1/2NS

Hypotonic - 1/2 NS, Do not give for patients at risk for increased ICP

**D5W is considered an isotonic solution to begin with, however, it becomes hypotonic after the body metabolizes the glucose.

In order to determine which solution would work best for a patient, you need to look at their labs, especially sodium and potassium. You also need to note their edema status, if they have heart or renal problems, or other outstanding pathologies, and how the fluid imbalance came into effect, as that could alter the type and rate of infusion.

Only give normal saline with blood.

In general...

NS treats mild hyponatremia (hypertonic saline for moderate/severe hyponatremia), metabolic alkalosis, shock.

D5W treats hypernatremia, dehydration

Lactated Ringers treats losses from burns and lower GI, dehydration, hypovolemia.

hypertonic saline for hyponatremia

burn out · May 7, 2006

Try not to get too stressed out and just remember the basics because in the real world the doctor orders what they want them to have no matter if you think it should be different or not.

Daytonite, BSN, RN · May 9, 2006

Try not to get too stressed out and just remember the basics because in the real world the doctor orders what they want them to have no matter if you think it should be different or not.

Excuse me! But in the real world it's a good idea to know what's appropriate despite what the doctor orders. Because if you give it and the patient suffers harm, the nurse is just as responsible as the doctor. I've seen doctors order what the nurses would say was their regular IV orders only to have some little old lady go into congestive failure because no one questioned the fluid or the continually fast rate it was ordered to run at. Nurses are supposed to think about everything they are doing on the job, not just blindly follow doctor's orders.

chris_at_lucas_RN, RN · May 9, 2006

Try not to get too stressed out and just remember the basics because in the real world the doctor orders what they want them to have no matter if you think it should be different or not.

This is true, except that if the doctor makes and error, and you administer what was ordered, it's you that's on the hook, not the doctor.

You need to know enough to have your red flags/lights/whatever go off if there is an error or a high risk situation, that will cause you to stop, think, look it up, verify, ask another nurse, etc.

And the post above that addressed which way the IV fluid will affect the vascular component is a big part of what will help you do that.

And the rest of it, you need to pass your exams and the boards.

It will probably start to make sense if you think in terms of what is the patient's problem. Low BP? You want to increase what is in the vessels, to increase the BP, and that will be.....

The other issue does have to do with electrolytes. If they are out of balance, the IV therapy gets tweaked.

Or so I'm told.

David's Harp · May 9, 2006

Wow - lot's of great info (esp. Daytonite) in this thread. Not meaning to threadjack, but it really does benefit others when someone asks a question. Thanks mani3433, all.